Transgender Youth More Likely to Have Autism

Nearly a quarter of young persons diagnosed with gender dysphoria, or who are transgender, screened positive for Asperger syndrome, a form of autism, according to a new paper in the academic journal LGBT Health.
The study was a small retrospective review of intake files of 39 children at Boston Children’s Hospital. Lead author Dr. Daniel E. Shumer explains, “We found that 23 percent of kids fell into the ‘possible, likely or very likely category’ when using the evaluation tool to screen for Asperger’s.”
Asperger’s is a term that has been used to describe “higher functioning” autism spectrum disorder, or kids that have elements of autism spectrum disorder but are still able to communicate and have social interactions, he says. Some persons with Asperger’s have become particularly adept at writing computer code.
The findings complement a 2010 study from Amsterdam that used more rigorous diagnostic criteria for autism in evaluating 204 youth at a clinic for gender dysphoria. It found that 7.8 percent of those children also met the criteria for having autism; that compares with an autism rate of 0.6 to 1 percent that other studies have found in the general population.
John Strang looked to see if the reverse was also true. He examined records of 1,605 children treated at Children’s National Hospital in Washington, DC, in a paper published in 2013, and found that 5.4 percent of the parents of children with autism and 4.8 percent with attention deficit hyperactivity disorder (ADHD) also reported gender variant behavior in their child.
“Having autism is a burden; a lot of things in the world change when you have autism,” says Strang. “But adding transgenderism, or maybe some of them aren’t transgender but they are just exploring gender, that is complicated in itself.”
He anticipated that dealing with both issues might increase the level of anxiety for these kids. But it turns out, that was not always the case.
Often the kids with autism “weren’t really noticing the social expectations or the social biases as much as someone without autism,” says Strang. “They were less anxious about the trans piece, they were less worried about what people thought,” and more accepting of their own sense of identity.
But at the same time, having both conditions adds another layer of complexity. He says, “Knowing how to navigate in a world that is not really friendly with people who are trans can be tricky when you are missing social cues.”
Shumer says it is important that parents and medical providers be aware of the increased possibility for co-occurrence of autism and gender variance. If treating patients for one condition, they should screen for the other and be prepared to treat it.
“There also may be implications for how to provide informed consent for things like hormonal interventions,” he adds.
Strang shares those concerns. He has been working with others to develop recommendations on how to best address the needs of people dealing with both autism and gender dysphoria. They hope to publish that paper later this year.